2026 Rules Active
2026 Strategy Validated
Hospital Safety Net + Emergency Room
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Actuarial Strategy Reference
This strategy is generated based on the 2026 Council for Medical Schemes (CMS) registered rules and actuarial pricing matrices.
VERIFIED: 2025-12-20 | SOURCE: SCHEME_BENEFIT_GUIDE_2026
Similar Situations
Key Terms Explained
Key Terms for this Strategy
- Network Restriction
- You must use hospitals and doctors listed in the scheme's specific network. Voluntary use of non-network providers will result in a heavy co-payment. [Source: Council for Medical Schemes Official Benefit Rules]
- Elective Procedure Co-payment
- A mandatory upfront fee you must pay to the hospital for specific scheduled surgeries that are not emergencies. [Source: Council for Medical Schemes Official Benefit Rules]
- PMB (Prescribed Minimum Benefits)
- By law, this plan must cover the costs of 27 specific chronic conditions and emergency treatments. [Source: Council for Medical Schemes Official Benefit Rules]
Common Questions
Does Hospital Standard cover hip and knee replacements? [Hospital Standard Single Disaster Cover PMB Only]
No. The plan explicitly excludes cover for joint replacements and back/neck surgery, unless it qualifies as a Prescribed Minimum Benefit (PMB). Strategy reference: pmb-2026.
Is there a co-payment for a gastroscopy? [Hospital Standard Single Disaster Cover PMB Only]
Yes, a R2,020 co-payment applies to gastroscopies and colonoscopies performed in hospital. You also face a R6,500 penalty if you don't use a day hospital. Strategy reference: pmb-2026.
Can I go to any hospital? [Hospital Standard Single Disaster Cover PMB Only]
No. You must use a hospital on the Hospital Standard Network. If you use a non-network hospital for a planned procedure, you will pay a 30% co-payment. Strategy reference: pmb-2026.
What is the limit for cancer treatment? [Hospital Standard Single Disaster Cover PMB Only]
Non-PMB cancer treatment is limited to R168,100 per family. Once depleted, you have 80% cover at a DSP and no cover at a non-DSP. Strategy reference: pmb-2026.
Are MRI scans covered? [Hospital Standard Single Disaster Cover PMB Only]
Yes, but they are limited to R32,040 per family and require a R2,800 co-payment per scan (unless it is a PMB). Strategy reference: pmb-2026.
Does this plan cover depression medication? [Hospital Standard Single Disaster Cover PMB Only]
Yes, it covers depression medication up to R165 per beneficiary per month, in addition to the standard 27 chronic conditions. Strategy reference: pmb-2026.
Do I get free casualty visits? [Hospital Standard Single Disaster Cover PMB Only]
Yes, you are covered for 2 emergency consultations per family at a casualty ward, but this benefit is strictly limited to emergencies only. Strategy reference: pmb-2026.
Is pregnancy covered? [Hospital Standard Single Disaster Cover PMB Only]
Yes, you get 6 antenatal consultations, 2 ultrasound scans, and post-birth paediatric visits, funded from the risk benefit. Strategy reference: pmb-2026.
Hospital Standard Single Disaster Cover PMB Only strategy verified
Covering 0 family members
2026 rates applied